Perforations in bodily walls may be naturally occurring, or formed intentionally or unintentionally. In order to permanently close these perforations and allow the tissue to properly heal, numerous medical devices and methods have been developed employing sutures, adhesives, clips, staples and the like. One class of such devices is commonly referred to as tissue anchors, T-anchors or visceral anchors. Exemplary tissue anchors are disclosed in U.S. Pat. No. 5,123,914, U.S. application Ser. No. 11/946,565, and U.S. Provisional Application No. 61/166,364, entitled “Tissue Anchors and Medical Devices for the Rapid Deployment of Tissue Anchors” to Ducharme, the entire contents of which are incorporated by reference herein.
Multiple tissue anchors may be used to close a perforation. Difficulties arise in sequentially deploying multiple tissue anchors because the distal-most tissue anchor is being pushed directly upon by an adjacent tissue anchor. Thus, as the distal-most tissue anchor is deployed, the proximally adjacent tissue anchor is already partially deployed and can easily fall out of the introduction needle. Moreover, deploying numerous tissue anchors individually can be tedious and time consuming due to reloading the various tissue anchors into the introduction needle and individually deploying the tissue anchors. There is also difficulty in maintaining the position of the device, while a new tissue anchor is loaded and placed back through the device.
Tissue anchors typically include a crossbar or some anchoring member connected to suture. The anchoring member and suture may take many forms, but generally a needle is used to pierce tissue and deliver the anchoring member on one side of the tissue, leaving the suture extending back to the other side of the tissue. The sutures of one or more tissue anchors are collected and connected together, such as through tying the sutures together. Manually tying suture strands together to close a perforation can be very complex and time consuming. For example, a significant level of skill and coordination is required by the medical professional, especially when the perforation and sutures are difficult to access within the body, such as in endoscopic or laparoscopic procedures. The numerous difficulties with manually tying sutures are well documented. In order to address these and other issues of manual suture tying, various automatic suture tying systems have been developed. Unfortunately, such automatic systems are often complex and costly, difficult to use, and limited to use in certain situations.